Severe cheek and lower eyelid lymphedema after resection of
oropharyngeal tumor and radiation.
J Craniofac Surg. 2010 Ma
Silverman AT, Hoffman R, Cohen M, Garza R.
University of Illinois Medical Center at Chicago, Illinois 60612, USA.
Facial lymphedema, a rare condition with poorly understood
pathogenesis, is commonly associated with previous infection,
radiation therapy, local tumor growth, or previous surgery in the head
and neck region. Few cases of isolated facial lymphedema have been
reported in the literature. Surgical excision has emerged as the
mainstay of therapy in such cases, although the long-term efficacy and
recurrence rate after excision remain unknown. We present a unique
case of a patient with severe unilateral facial lymphedema, which
manifested many years after extirpation of a floor-of-the-mouth
squamous cell carcinoma, bilateral supraomohyoid neck dissections, and
radiation therapy. The massive cheek and eyelid lymphedema, which
extended from the patient's left lower eyelid to patient's oral
commissure measured 11 x 15 cm with a thickened, brawny, lobulated,
and bosselated skin surface. This mass interfered with activities of
daily life, caused poor oral intake, and contributed to the patient's
severe kyphosis. Because the mass did not clinically or radiologically
appear to be malignant, we decided to perform a salvage procedure
consisting of wide excision of the massive lymphedematous mass and
immediate coverage with a split-thickness skin grafting. Temporary
tarsorraphy sutures were also used to provide support to the lower
eyelid. The patient tolerated the procedure well, with no
complications and with full take of the skin graft. Postoperatively,
he was very grateful to be relieved of his debilitating symptoms.
Journal of Craniofacial Surgery:
March 2010 - Volume 21 - Issue 2 - pp 598-601
Brief Clinical Studies